Putting psychology in policy

Daniela Ligiero, PhD, says her life sometimes feels like an episode of "The West Wing" — high on excitement, low on predictability.

For a week last summer, for example, she flew to Tanzania to meet with community leaders, hospital workers and Ministry of Health staff to evaluate the country's efforts to respond to gender-based violence as part of the national HIV/AIDS program. The next week, she stayed strapped to her desk at the U.S. Department of State, where she prepared her boss for a meeting with high-level government officials, including Secretary of State John Kerry. The week after that, she presented her office's work addressing gender-based violence to representatives of the United Nations.

"The thing I love about my job is that it's so different every week, every day," says Ligiero, the senior gender technical advisor for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a government initiative that aims to save lives affected by HIV/AIDS globally. Since beginning her position in 2010, Ligiero, who speaks four languages, has traveled to about 20 countries, including Ukraine, Haiti and South Africa. "Some days you go in thinking your day is going to look one way and then something happens and everything changes."

What she does

Part of Ligiero's job is to make sure PEPFAR, which is coordinated out of the U.S. Department of State, considers gender issues — such as gender-based violence, masculinity norms and access to reproductive health care — when it decides which HIV/AIDS programs to support with its $6 billion in annual funding. She also suggests ways programs funded by PEPFAR can integrate gender-based issues into their work, and oversees monitoring and evaluation efforts to evaluate programs' effectiveness.

Right now, for example, the office is funding an intervention in Tanzania that provides victims of gender-based violence with immediate, comprehensive care, including HIV prophylaxis that stops the virus if taken within 72 hours of exposure. Ligiero helped write the plan for how the funds are used and continues to advise program administrators and the Tanzanian Ministry of Health on how it should be rolled out based on evidence. "As a psychologist … I get to bring all of that knowledge base of what works, what doesn't and what we need to evaluate more to our programs," she says.

Thanks to this program and others, over the past three years, PEPFAR has provided post-rape care to nearly 85,000 survivors of sexual violence in 19 countries.

A different level of communication

One challenge of Ligiero's job is taking evidence-based preventive practices and applying them to the developing world. "Where the U.S. was 50 years ago [in terms of gender-based violence] is where we are in many countries today," she says. In Mozambique, for example, marital rape wasn't a crime until very recently. In the Democratic Republic of Congo, rape is a weapon of war. "The devastation it causes the entire community — it's like the whole community has PTSD," she says. "The intervention has to be so much bigger than a clinical service or punishing the perpetrators."

In such cases, Ligiero's background as a psychologist serves her well. She supports the implementation of U.S. government programs that train community and religious leaders on gender-based violence prevention and that partner with community members in Mozambique, for example, to make sure women know their rights. "Starting that dialogue and having those leaders engaged are really important," Ligiero says. "It's a different level of communication."

How she got there

As a graduate student, Ligiero thought she would be a clinician or a researcher focusing on violence. But, she says, "the more I did work on violence, the more I realized this is less about changing individual behaviors than it is about changing policy and societal structures." She found her calling in policy during her postdoctorate year as an APA congressional fellow, a partnership with the American Association for the Advancement of Science (AAAS). Ligiero went on to become an AAAS Diplomacy Fellow and then a staff member in the State Department's Office of the U.S. Global AIDS Coordinator, where she works today. "I realized that policy- and decision-makers value the technical input I could bring to the table," she says.

Today, as the only psychologist in an office of public health, medical and policy experts, Ligiero also brings a deep understanding of research, the importance of evidence-based interventions and the complexity of how behavior change, culture and gender intersect to affect health outcomes. "It's fun because I get to bring in that perspective to a world that doesn't have a lot of psychologists in it."

Breaking the silence

Ligiero's work has personal meaning, too. As a survivor of sexual violence, she's particularly proud of PEPFAR projects that facilitate open dialogue about these issues. One example is a program that trains young survivors in South Africa to be journalists and peer educators around the issue of gender-based violence. One graduate, Mandisa, has become an international spokeswoman, even creating a documentary about her experience contracting HIV from a rape at age 7.

"There's a lot of silence around what it means to have experienced sexual violence," Ligiero says. "We need more of those people who are really able to put it out there."

Disclaimer: The views expressed in this publication are solely the opinions of the subject and authors and do not necessarily reflect the official policies of any of the U.S. government departments and agencies cited here, nor does mention of the department or agency names imply endorsement by the U.S. government.